Malinova Vesna, von Eckardstein Kajetan, Rohde Veit, Mielke Dorothee
Department of Neurosurgery, Georg August University Göttingen, Germany.
Department of Neurosurgery, Georg August University Göttingen, Germany.
Clin Neurol Neurosurg. 2015 Oct;137:79-82. doi: 10.1016/j.clineuro.2015.06.021. Epub 2015 Jul 2.
The intraoperative microvascular Doppler sonography (iMDS) is a well-established tool in vascular surgery for blood flow velocity (BFV) monitoring, capable of detecting vessel occlusion. However, identification of subtotal vessel compromise is more difficult, since the measured BFV may substantially vary with changing insonation angles and insonated vessel segments. To keep these parameters constant we combined neuronavigation with iMDS (niMDS). The question was if niMDS allows the detection of subtotal vessel compromise in aneurysm surgery.
During surgery, the 3-dimensional reconstruction of the CT-angiography, which was obtained routinely prior to surgery, was displayed by the neuronavigational system. Prior to clipping, neuronavigation was used to define target point and trajectory, which, by coupling the neuronavigational pointer with the Doppler probe, correspond to the insonated vessel segment and the insonation angle. After clipping, for each vessel segment, the same trajectory was used for all consecutive measurements. The mean BFVs pre- and post-clipping were documented.
We performed 82 BFV-measurements in 39 aneurysm surgeries. Mean deviation between pre- and post-clipping BFV values was 2.12cm/s. There was a significant correlation between the mean BFV values before and after clipping (r=0.45 [95% CI 17-66%]; p=0.002). One patient experienced new neurological deficits due to occlusion of a perforating vessel that was not insonated.
The study could not answer the question if niMDS can detect BFV changes after clipping indicating vessel compromise, as no subtotal vessel occlusion occurred in the 39 operations. However, we proofed that niMDS-measured BFVs only varied minimally in uncompromised vessels pre- and post-clipping, suggesting that vessel compromises might be easily detected during aneurysm surgery.
术中微血管多普勒超声检查（iMDS）是血管外科中用于监测血流速度（BFV）的成熟工具，能够检测血管闭塞。然而，识别血管部分受损更为困难，因为测量的BFV可能会随着声束角度和被检测血管节段的变化而大幅改变。为了保持这些参数恒定，我们将神经导航与iMDS相结合（niMDS）。问题是niMDS是否能在动脉瘤手术中检测到血管部分受损。
在手术过程中，神经导航系统显示术前常规获取的CT血管造影的三维重建图像。在夹闭之前，使用神经导航来定义靶点和轨迹，通过将神经导航指针与多普勒探头耦合，使其对应于被检测的血管节段和声束角度。夹闭后，对于每个血管节段，在所有连续测量中使用相同的轨迹。记录夹闭前后的平均BFV。
我们在39例动脉瘤手术中进行了82次BFV测量。夹闭前后BFV值的平均偏差为2.12cm/s。夹闭前后的平均BFV值之间存在显著相关性（r = 0.45 [95% CI 17 - 66%]；p = 0.002）。一名患者因未被检测到的穿支血管闭塞出现了新的神经功能缺损。
由于在这39例手术中未发生血管部分闭塞，该研究无法回答niMDS是否能检测到夹闭后表明血管受损的BFV变化这一问题。然而，我们证明了在未受损血管中，niMDS测量的BFV在夹闭前后仅发生了极小的变化，这表明在动脉瘤手术中可能很容易检测到血管受损情况。
